Mammographic and Ultrasonographic Imaging Analysis for Neoadjuvant Chemotherapy Evaluation: Volume Reduction Indexes That Correlate With Pathological Complete Response.

INTRODUCTION: We aimed to evaluate volume reduction in digital mammography (DM) and ultrasound (US) for neoadjuvant chemotherapy (NAC) evaluation, with breast cancer-specific survival and pathological complete response (pCR) associations. METHODS: This is a retrospective observational cohort study analyzing recorded images in 122 selected subjects out of which 569 patients presented with advanced breast cancers. Spearman's correlation and generalized estimating equations (GEE) compared volume reduction on DM and US between pCR and non-pCR after NAC with post-surgical anatomopathology. Cox regression and Kaplan-Meier curves analyzed associations between cancer-specific survival, pCR, and volume reductions. RESULTS: A total of 34.4% (N=42) obtained pCR and 65.6% (N=80) did not. Minimum percentage indexes needed to correlate with pCR over time were, at least, 28.9% for DM (p=0.006) and 10.36% for US (p=0.046), with high specificity (US=98%, DM=93%) but low sensitivity (US=7%, DM=18%). Positive predictive values were 82% (DM) and 86% (US) and negative predictive values were 37% (DM) and 36% (US). Cox regression and Kaplan-Meier curves demonstrated associations of breast cancer-specific survival with pCR (Cox regression coefficient {B}=0.209, CI 95%=0.048-0.914, p=0.038). CONCLUSIONS: At least 28.9% of volume reduction on DM and 10.36% of volume reduction on US are correlated with pCR. Furthermore, pCR was associated with breast cancer-specific survival after NAC in volumetric morphological imaging analysis.

Breast cancer mammographic diagnosis performance in a public health institution: a retrospective cohort study.

OBJECTIVES: To evaluate the quality assurance of mammography results at a reference institution for the diagnosis and treatment of breast cancer in southern Brazil, based on the BIRADS (Breast Imaging Reporting and Data System) 5th edition recommendations for auditing purposes. MATERIALS AND METHODS: Retrospective cohort and cross-sectional study with 4502 patients (9668 mammographies)) who underwent at least one or both breast mammographies throughout 2013 at a regional public hospital, linked to a federal public university. The results were followed until 31 December 2014, including true positives (TPs), true negatives (TNs), false positives (FPs), false negatives (FNs), positive predictive values (PPVs), negative predictive value (NPV), sensitivity and specificity, with a confidence interval of 95%. RESULTS: The study showed high quality assurance, particularly regarding sensitivity (90.22%) and specificity (92.31%). The overall positive predictive value (PPV) was 65.35%, and the negative predictive value (NPV) was 98.32%. The abnormal interpretation rate (recall rate) was 12.26%. CONCLUSIONS: The results are appropriate when compared to the values proposed by the BIRADS 5th edition. Additionally, the study provided self-reflection considering our radiological practice, which is essential for improvements and collaboration regarding breast cancer detection. It may stimulate better radiological practice performance and continuing education, despite possible infrastructure and facility limitations. MAIN MESSAGES: • Accurate quality performance rates are possible despite financial and governmental limitations. • Low-income institutions should develop standardised teamwork to improve radiological practice. • Regular mammography audits may help to increase the quality of public health systems.